Insurance Ch 4

Question 1

Traditional Medicare consist of hospital insurance protection (_______) and medical insurance protection (_______).

Answer 1

Part A/part B

Question 2

All persons, age 65, and over, who are entitled to, but not necessarily receiving, monthly, Social Security, cash, benefits, or monthly benefits, under railroad retirement programs are eligible for Medicare _____.

Answer 2

Part A hospital insurance

Question 3

A Social Security disability beneficiary _______ covered under Medicare after entitlement to disability benefits for 24 months or more.

Answer 3

IS

Question 4

When a person has covered by an employer group, health insurance plan, is entitled to veterans benefits, or is covered by Worker’s Compensation, Medicare is the ______.

Answer 4

Secondary payor

Question 5

Medicare part ______ is financed through monthly premiums paid by those who enroll plus contributions from the federal government. The patient pays a deductible first. Medicare pays ___ of the balance of the approved charges. No stop-loss applies, leaving the client with significant financial exposure.

Answer 5

Part B / 80%

Client exposed to 20% of an unlimited amount

Question 6

Routine, dentures and dental care, exams for eyeglasses or hearing aids, most immunizations, prescription drugs are _____ Medicare part B.

Answer 6

Excluded from

Question 7

Skilled nursing home stay and the hospital stay are Medicare _____ coverages.

Answer 7

A

Question 8

Medicare B coverage for prescription drugs is limited to ______.

Answer 8

Drugs which cannot be self administered.

Question 9

Medicare _______ refers to plans run by insurance companies approved by Medicare.

 Drug manufacturers must generally provide a ______

Answer 9

Part D / 50% discount

Question 10

______ policies are only available to individuals currently enrolled in both Medicare part A and part B.

Answer 10

Medigap

Question 11

A(n) _______ provides a wide range of comprehensive healthcare services to a group of subscribers in return for payment and delivery features for a fixed premium.

Answer 11

HMO. Health maintenance organization.

Question 12

A monthly fee is paid to the provider. In return, the individual receives virtually all the medical care required during the year.

Answer 12

Capitation

Question 13

Care is managed by a primary care physician, who is responsible for determining what care is provided, and when the individual should be referred to specialist

Answer 13

Gatekeeper

Question 14

True or false:

The subscriber is covered when he/she uses a provider other than the HMO

Answer 14

False

Besides having to go through a gatekeeper, the subscriber is not covered when he/she uses a provider other than the HMO, unless for an emergency.

Question 15

Healthcare providers in the _______ are generally paid on a fee for service basis as needed

Answer 15

PPO preferred provider organization

Question 16

Subscribers are not required to use practitioners or facilities of the _____. They can go outside of the network, but benefits are generally reduced relative to benefits paid for network, provided care.

Answer 16

Preferred provider organization
PPO

Question 17

With regards to group, medical insurance, premiums for employees’ and employees’ dependents’ coverage are ______ by the employer.

Answer 17

Tax deductible 

Question 18

If the COBRA triggering event is termination, the employee and the employee’s spouse and dependents have coverage for up to _______.

Answer 18

18 months.

Question 19

If the COBRA, triggering event is divorce, the employee’s spouse can be covered under the group health insurance policy for up to _____.

Answer 19

36 months

Question 20

Savings accounts that operate alongside a high deductible health plan.

Answer 20

Health savings accounts (HSAs)

Question 21

Contributions by individual to an HSA are _______ for federal income tax purposes.

Answer 21

Deductible

Question 22

Employer contributions to an HSA are ________.

Answer 22

Tax deductible by the employer

Question 23

Distributions from HSAs can be for healthcare, needs not covered by the high deductible policy and are ______.

Answer 23

Tax-free

Question 24

Penalties for non-medical HSA withdrawals are now ______ of the distribution, if under age 65.

Answer 24

20%

Question 25

Money remaining in an HSA account at age 65 or older that is withdrawn for a purpose. Other than healthcare is _______.

Answer 25

Taxed at ordinary income tax rates.

There is no 20% penalty when the insured reaches the age of Medicare eligibility.

Question 26

Over-the-counter drugs now ____ qualify as an eligible medical expense

Answer 26

Do

Question 27

If an employee drops healthcare coverage because he is eligible for Medicare, his family (not him) may elect COBRA coverage for _____ months.

Answer 27

36

Question 28

The COBRA election period starts with the date of the _______ and lasts for _____ days.

Answer 28

Notification / 60